Healthcare Provider Details

I. General information

NPI: 1790338747
Provider Name (Legal Business Name): ISABEL M. CORDERO MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2019
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

784 W 51ST PL
HIALEAH FL
33012-3624
US

IV. Provider business mailing address

784 W 51ST PL
HIALEAH FL
33012-3624
US

V. Phone/Fax

Practice location:
  • Phone: 786-587-0509
  • Fax:
Mailing address:
  • Phone: 786-587-0509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA78360
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: